Bullous pemphigoid (BP) is the most frequent autoimmune bullous disease. Little is known on factors that influence the prognosis. We here report first results of a retrospective cohort study on risk factors for repeated hospitalization and death in patients with BP. The study is conducted concurrently in four centers comprising patients diagnosed with BP from 1986-1997. The patients were recruited based on admission records and/or immunofluorescence findings. A total of 500 patients is expected to be included finally. Univariate (Kaplan-Meier) and multivariate (Cox regression analysis) was performed using SAS . We report on 60 patients (45% females) with a mean age + standard deviation (SD) of 76.5 years (SD 12.5). Based on a response rate of 70% and a follow-up period of 2.4 years (SD 3.11) we were able to find increased multivariate risk estimates [95% Confidence Intervals] for repeated hospitalizations of 7.8 [1.1, 58] for mucous membrane involvement, 8.3 [1.3, 56.1] for elevated BP antibody titers (≥ 1:5160 / 75% quantile) and 9.4 [1.3, 66] for elevated glucose levels ≥ 130 mg/dl. These estimates were controlled for age and gender. For death the major risk factor was age with a multivariate risk estimate of 13.4 [2.3, 79.7] for >79 years (median) at admission. The only other risk factor that remained was a higher dosage of glucocorticosteroids at discharge (>40 mg / 75% quantile) with 3.7 [0.8, 16.6] when controlling for age and gender. For the first time, we were able to identify variables for an increased risk of hospitalization and death in patients with BP. Patients with BP and mucosal involvement, elevated antibody titers and glucose levels have to be closely monitored to prevent repeated hospitalization. Death in BP patients is mainly associated with age. So far no other risk factor could be identified besides a higher dosage of glucocorticosteroids at discharge which might point to an increased severity of the disease or a higher incidence of glucocorticosteroid related complications.